Siddhartha G Kapnadak1, Gregory A Kicska2, Kathleen J Ramos3, Desiree A Marshall4, Tamara Y Carroll5, Sudhakar N Pipavath6, Michael S Mulligan7, Christopher H Goss8, Moira L Aitken9. 1. Department of Medicine, Division of Pulmonary, Critical Care, and Sleep Medicine, University of Washington School of Medicine, 1959 NE Pacific Street, Seattle, WA 98195, United States. Electronic address: skap@uw.edu. 2. Department of Radiology, University of Washington School of Medicine, 1959 NE Pacific Street, Seattle, WA 98195, United States. Electronic address: kicskag@uw.edu. 3. Department of Medicine, Division of Pulmonary, Critical Care, and Sleep Medicine, University of Washington School of Medicine, 1959 NE Pacific Street, Seattle, WA 98195, United States. Electronic address: ramoskj@uw.edu. 4. Department of Pathology, University of Washington School of Medicine, 1959 NE Pacific Street, Seattle, WA 98195, United States. Electronic address: damarsh@uw.edu. 5. Department of Radiology, University of Washington School of Medicine, 1959 NE Pacific Street, Seattle, WA 98195, United States. Electronic address: tyc5@uw.edu. 6. Department of Radiology, University of Washington School of Medicine, 1959 NE Pacific Street, Seattle, WA 98195, United States. Electronic address: snjp@uw.edu. 7. Division of Cardiothoracic Surgery, University of Washington School of Medicine, 1959 NE Pacific Street, Seattle, WA 98195, United States. Electronic address: msmmd@uw.edu. 8. Department of Medicine, Division of Pulmonary, Critical Care, and Sleep Medicine, University of Washington School of Medicine, 1959 NE Pacific Street, Seattle, WA 98195, United States; Department of Pediatrics, Division of Pediatric Pulmonology, University of Washington School of Medicine, 1959 NE Pacific Street, Seattle, WA 98195, United States. Electronic address: CGoss@medicine.washington.edu. 9. Department of Medicine, Division of Pulmonary, Critical Care, and Sleep Medicine, University of Washington School of Medicine, 1959 NE Pacific Street, Seattle, WA 98195, United States. Electronic address: moira@uw.edu.
Abstract
BACKGROUND: Tracheal diverticula (TD) are rare anomalies that may harbor infected secretions, posing potential risk to patients with lung disease. In an end-stage cystic fibrosis (CF) cohort, we describe the characteristics and associated post-lung transplant (LTx) outcomes of TD. METHODS: Pre-transplant computed tomography (CT)'s were reviewed in CF patients undergoing LTx. TD were characterized radiographically and on autopsy when available. Pre-transplant clinical variables and post-transplant outcomes were compared by TD status. RESULTS: Of 93 patients, 35 (37.6%) had TD. 58% of TD had fat-stranding, and post-mortem TD examinations revealed histology carrying intense submucosal inflammation, and purulent contents that cultured identical species to sputum. There was no difference in post-LTx survival [HR 1.77 (0.82-3.82), p=0.147], bacterial re-colonization, or rejection in patients with TD compared to those without. Patients with TD were more likely to die from infection, but the result was not statistically significant [HR 2.02 (0.62-6.63), p=0.245]. CONCLUSIONS: We found a high prevalence of TD in end-stage CF, where diverticula may represent a large-airway bacterial reservoir. TD were not associated with differences in post-LTx outcomes, but given the infectious concerns further investigation is necessary.
BACKGROUND:Tracheal diverticula (TD) are rare anomalies that may harbor infected secretions, posing potential risk to patients with lung disease. In an end-stage cystic fibrosis (CF) cohort, we describe the characteristics and associated post-lung transplant (LTx) outcomes of TD. METHODS: Pre-transplant computed tomography (CT)'s were reviewed in CF patients undergoing LTx. TD were characterized radiographically and on autopsy when available. Pre-transplant clinical variables and post-transplant outcomes were compared by TD status. RESULTS: Of 93 patients, 35 (37.6%) had TD. 58% of TD had fat-stranding, and post-mortem TD examinations revealed histology carrying intense submucosal inflammation, and purulent contents that cultured identical species to sputum. There was no difference in post-LTx survival [HR 1.77 (0.82-3.82), p=0.147], bacterial re-colonization, or rejection in patients with TD compared to those without. Patients with TD were more likely to die from infection, but the result was not statistically significant [HR 2.02 (0.62-6.63), p=0.245]. CONCLUSIONS: We found a high prevalence of TD in end-stage CF, where diverticula may represent a large-airway bacterial reservoir. TD were not associated with differences in post-LTx outcomes, but given the infectious concerns further investigation is necessary.
Authors: Roger D Yusen; Leah B Edwards; Anne I Dipchand; Samuel B Goldfarb; Anna Y Kucheryavaya; Bronwyn J Levvey; Lars H Lund; Bruno Meiser; Joseph W Rossano; Josef Stehlik Journal: J Heart Lung Transplant Date: 2016-09-13 Impact factor: 10.247
Authors: M C Berkhout; C J van Rooden; E Rijntjes; W J Fokkens; L H el Bouazzaoui; H G M Heijerman Journal: J Cyst Fibros Date: 2013-11-05 Impact factor: 5.482
Authors: J Gottlieb; F Mattner; H Weissbrodt; M Dierich; T Fuehner; M Strueber; A Simon; T Welte Journal: Respir Med Date: 2008-12-30 Impact factor: 3.415